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Corriger J, Beaudouin E, Rothmann R, Penven E, Haumonte Q, Thomas H, Picaud J, Nguyen-Grosjean VM, Corriger-Ippolito J, Braun F, De Talancé M, Auburtin B, Atain-Kouadio P, Borsa-Dorion A, Baugnon D, De Carvalho M, Jaussaud R, Nguyen-Thi PL, Bollaert PE, Demoly P, Tanno LK. Epidemiological Data on Anaphylaxis in French Emergency Departments. J Investig Allergol Clin Immunol 2018; 29:357-364. [PMID: 30411700 DOI: 10.18176/jiaci.0348] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although anaphylaxis has been considered a priority public health issue in the world allergy community, epidemiological data on morbidity and mortality remain suboptimal. We performed the first multicenter epidemiological study in French emergency departments (EDs). The study covered 7 EDs over a period of 1 year. The objectives were to identify areas that are amenable to change and to support ongoing national and international efforts for better diagnosis, management, and prevention of anaphylaxis. METHODS Ours was a descriptive study based on data routinely reported to French institutional administrative databases from 7 French public health institutions in the Lorraine region between January and December 2015. Data were collected based on the anaphylaxisrelated codes of the International Classification of Diseases (ICD)-10, and cases were clinically validated as anaphylaxis. RESULTS Of the 202 079 admissions to the EDs, 4817 had anaphylaxis-related codes; of these, 323 were clinically validated as anaphylaxis. Although 45.8% were severe, adrenaline was prescribed in only 32.4% of cases. Of the 323 cases, 57.9% were subsequently referred for an allergy work-up or evaluation (after or during hospitalization), and 17.3% were prescribed autoinjectable epinephrine. CONCLUSION Our results highlight an urgent need for improved public health initiatives with respect to recognition and treatment of anaphylaxis. We flag key problems that should be managed in the coming years through implementation of national and international actions.
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Affiliation(s)
- J Corriger
- Allergy Department, Hospital Emile Durkheim, Epinal, France.,Internal Medicine and Clinical Immunology Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - E Beaudouin
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | - R Rothmann
- Emergency Department, Hospital Mercy-Metz, Ars-Laquenexy, France
| | - E Penven
- Occupational Diseases Department, University Hospital, Vandoeuvre-lès-Nancy, France.,Division of Allergy, Dermatology Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - Q Haumonte
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | - H Thomas
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | - J Picaud
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | | | - J Corriger-Ippolito
- Division of Allergy, Dermatology Department, University Hospital, Vandoeuvre-lès-Nancy, France.,Emergency Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - F Braun
- Emergency Department, Hospital Mercy-Metz, Ars-Laquenexy, France
| | - M De Talancé
- Emergency Department, Hospital Emile Durkheim, Epinal, France
| | - B Auburtin
- Pediatric Emergency Department, Hospital Emile Durkheim, Epinal, France
| | - P Atain-Kouadio
- Emergency Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - A Borsa-Dorion
- Pediatric Emergency Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - D Baugnon
- Emergency Department, Hospital of Verdun-Saint-Mihiel, Verdun, France
| | - M De Carvalho
- Biology and Immunology Laboratory, University Hospital, Vandoeuvre-lès-Nancy, France
| | - R Jaussaud
- Internal Medicine and Clinical Immunology Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - P L Nguyen-Thi
- Clinical Research Platform, ESPRI-BioBase Unit, University Hospital, Vandoeuvre-lès-Nancy, France
| | - P E Bollaert
- Medical Intensive Care Unit, University Hospital, Nancy, France
| | - P Demoly
- Division of Allergy, Department of Pulmonology, University of Montpellier, France and Sorbonne University, INSERM, IPLESP, EPAR team, Paris, France
| | - L K Tanno
- Division of Allergy, Department of Pulmonology, University of Montpellier, France and Sorbonne University, INSERM, IPLESP, EPAR team, Paris, France
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Picaud J, Beaudouin E, Renaudin JM, Pirson F, Metz-Favre C, Dron-Gonzalvez M, Moneret-Vautrin DA. Anaphylaxis to diclofenac: nine cases reported to the Allergy Vigilance Network in France. Allergy 2014; 69:1420-3. [PMID: 24931488 DOI: 10.1111/all.12458] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2014] [Indexed: 11/29/2022]
Abstract
Nine cases of diclofenac hypersensitivity recorded by the Allergy Vigilance Network in France from 2002 to 2012 were studied. Data from history, symptoms, skin tests, basophil activation tests, and oral challenge (OC) were recorded. Grade 3 severe anaphylactic reactions occurred in seven cases of nine. IgE-dependent anaphylaxis was confirmed in six cases: positive intradermal tests (n = 4), a syndromic reaction during skin tests (n = 1), and one case with grade 1 reaction and negative skin tests had an anaphylactic shock to the OC. A nonimmune reaction was suspected in one case. An IgE-dependent mechanism may be the predominant cause of adverse reactions to diclofenac. Allergy skin tests must be carried out sequentially at the recommended concentrations. BATs may be helpful because they can support the diagnosis of anaphylaxis. Given the risks of a direct challenge to diclofenac, OC to aspirin should be performed first to exclude a nonimmunologic hypersensitivity to NSAIDs. Tests for specific IgEs to most frequently used NSAIDs such as diclofenac and ibuprofen are urgently needed.
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Affiliation(s)
- J. Picaud
- Allergy Department; Emile Durkheim Hospital; Epinal France
- Allergy Vigilance Network; Vandoeuvre les Nancy France
| | - E. Beaudouin
- Allergy Department; Emile Durkheim Hospital; Epinal France
- Allergy Vigilance Network; Vandoeuvre les Nancy France
| | - J. M. Renaudin
- Allergy Department; Emile Durkheim Hospital; Epinal France
- Allergy Vigilance Network; Vandoeuvre les Nancy France
| | - F. Pirson
- Allergy Vigilance Network; Vandoeuvre les Nancy France
- Pneumology Department; Saint-Luc University Hospital; Bruxelles Belgium
| | - C. Metz-Favre
- Allergy Vigilance Network; Vandoeuvre les Nancy France
- Pneumology Department; New Civil Hospital; Strasbourg France
| | - M. Dron-Gonzalvez
- Allergy Vigilance Network; Vandoeuvre les Nancy France
- Allergy Vigilance Network; Martigues France
| | - D. A. Moneret-Vautrin
- Allergy Department; Emile Durkheim Hospital; Epinal France
- Allergy Vigilance Network; Vandoeuvre les Nancy France
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Beaudouin E, Defendi F, Picaud J, Drouet C, Ponard D, Moneret-Vautrin DA. Iatrogenic angioedema associated with ACEi, sitagliptin, and deficiency of 3 enzymes catabolizing bradykinin. Eur Ann Allergy Clin Immunol 2014; 46:119-122. [PMID: 24853572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
New concepts of idiopathic and iatrogenic angioedema underline the role of bradykinin, and the importance of catabolizing enzymes. A case is described of Angiotensin converting enzyme inhibitor (ACEi) and sitagliptin induced angioedema, where AO attacks decreased after the withdrawal of lisinopril but resolved only after the withdrawal of sitagliptin, an inhibitor of dipeptylpeptidase IV. ACE, aminopeptidase P and carboxypeptidase N were decreased down to 17%, 42%, 64% of median references values, and remained low one year after the interruption of these drugs: 56%, 28% and 50%, respectively. The combined deficiency of APP and CPN might enhance the inhibiting effect of the DPP IV inhibitor. The fact that this triple deficiency remained latent before and after the treatment indicates that searching for latent enzyme deficiencies should be carried out when there is intention to treat with a combination of drugs interfering with the bradykinin metabolism.
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Affiliation(s)
- E Beaudouin
- Service d'Allergologie, Centre Hospitalier E Durkheim, Epinal, France
| | - F Defendi
- French Reference Center for Angioedema, CREAK, Grenoble, France. Université Joseph Fourier, GREPI/AGIM CNRS FRE 3405, Grenoble, France
| | - J Picaud
- Service d'Allergologie, Centre Hospitalier E Durkheim, Epinal, France
| | - C Drouet
- French Reference Center for Angioedema, CREAK, Grenoble, France. Université Joseph Fourier, GREPI/AGIM CNRS FRE 3405, Grenoble, France
| | - D Ponard
- Laboratoire d'Immunologie IBP, Grenoble, France
| | - D A Moneret-Vautrin
- Service d'Allergologie, Centre Hospitalier E Durkheim, Epinal, France. Université de Lorraine Nancy, France
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Blanc V, Picaud J, Legros E, Bes M, Etienne J, Moatti D, Raynaud MF. [Infection after total hip replacement by Staphylococcus caprae. Case report and review of the literature]. Pathol Biol (Paris) 1999; 47:409-13. [PMID: 10418010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
We report a case of Staphylococcus caprae bone and joint infection, that illustrate difficulties to diagnose coagulase-negative staphylococci (CNS) orthopedic surgery infections, specially following implantation of prostheses. Four of 5 strains successivelly isolated from deep and/or peri-operative specimens during late infection after total hip replacement (THR) have been identified, using commercial systems and conventionnal tests, as S. caprae. Identity of biochemical profile, antibiotype and pulsotype of the 4 isolates confirmed the pathogenicity of this animal CNS, rarely described as a human pathogen. Analysis of the 24 S. caprae human cases previously described evidence a relation ship between this bacteria and bone and joint infections, with implantation of prosthetic material as supplementary risk factor. S. caprae, whose major identification criteria are resumed, may have previously been misidentified as some similar CNS; this bacteria is probably part of our normal flora but may be recognized as an opportunistic pathogen, responsible for both nosocomial and community acquired infections.
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Affiliation(s)
- V Blanc
- Laboratoire, Centre Hospitalier d'Antibes Juan-les-Pins, Antibes, France
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